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| HCA Order Form | 
| Division | East Florida Division | ||
| Site/Hospital | JFK Medical Center | ||
| Billing | Delivery | ||
| Name | Colleen.Cannon@HCAhealthcare.com | Name | Maritess Quinto | 
| George.Greene1@healthtrustpg.com | Maritess.Quinto@hcahealthcare.com | ||
| Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 5301 S. Congress Ave. | 
| Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | |
| Address Line 3 | Suite 1100 | Address Line 3 | |
| City | Nashville | City | Atlantis | 
| State | TN | State | FL | 
| ZIP | 37203 | ZIP | 33462 | 
| Items to Order | |||
| Code | Description | Quantity | Total ($) | 
| C17001 | Brayden Baby/Infant Replacement Lung (single) | 25 | $236.25 | 
| $0.00 | |||
| Sub-Total | $236.25 | ||
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